A major barrier to realizing the benefits of health information technology is "stovepiping" of clinical data in incompatible systems, creating what McDonald has called "islands of data." Availability of complete, accurate clinical data is especially critical for medication information relating to frail, chronically ill elders in Assisted Living (AL) and Skilled Nursing Facilities (SNFs), who are at greater risk for medication-related problems because of advanced age, frailty, high-risk medications, and multiple care providers. "Yet physician groups, hospitals, and other health care organizations operate as silos, often providing care without the benefit of complete information about the patient's condition, medical history, services provided in other settings, or medications prescribed by other clinicians" (IOM, 2003). To address this problem, we propose to implement and evaluate a Patient-Centered Medication Information System (PCMIS) to improve the health of frail, chronically ill elders in rural Oregon. The aims are to: 1) Provide secure access to accurate, complete, and current medication information for patients, clinicians, pharmacists, and nurses who prescribe, dispense, or administer medications; 2) Reconcile differences in medication information in separate, often discordant information systems of clinics, pharmacies, and residential care facilities; 3) Reduce medication errors and adverse effects by eliminating interactions, duplications, and inappropriate medications; 4) Provide a platform for evidence-based decision support and public health monitoring to improve the quality and efficiency of care; 5) Assess benefits and costs of the system through robust evaluation; and 6) Extend this information integration model statewide and beyond via the Oregon Rural Practice Based Research Network (ORPRN).This project is the work of a consortium of (a) rural providers and community organizations with a record of collaboration to implement technology; (b) organizational support of ORPRN; and (c) scientific expertise of University faculty in computer science, informatics, medicine, nursing, pharmacy, and epidemiology. [unreadable] [unreadable]